Long-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention with or without Preprocedural Exercise Stress Test
Long-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention with or without Preprocedural Exercise Stress Test
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DOI：
10.3346/jkms.2020.35.e3
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发表时间：
2020-01-06
影响因子：
4.5
通讯作者：
Hahn, Joo-Yong
中科院分区：
文献类型：
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作者：
Kim, Jihoon;Lee, Joo Myung;Hahn, Joo-Yong
背景资料：尽管目前的指南建议在选择性经皮冠状动脉介入治疗（PCI）之前进行无创负荷试验，但尚不清楚先行运动负荷试验（EST）是否会影响因稳定性缺血性心脏病（SIHD）接受PCI的患者的结局。本研究的目的是调查择期PCI患者的长期结局，有或没有EST.Methods：我们研究了2,674例择期PCI患者使用药物洗脱支架SIHD。患者被分为2组：试验组在PCI前180天内接受了EST，结果呈阳性（n = 668），而非试验组未接受任何无创负荷试验（n = 2，006）。结果：PCI术后5年以上，试验组的全因死亡或心肌梗死（MI）风险显著低于非试验组（3.3% vs. 10.9%;校正的风险比[HR]，0.34; 95%置信区间[CI]，0.22-0.55; P < 0.001），在倾向评分匹配的人群中，（668对）（3.3% vs. 6.3%;校正HR，0.52; 95% CI，0.30-0.89; P = 0.018）。然而，两组之间的任何血运重建的发生率总体上相似（16.7% vs. 16.8%;校正HR，0.99; 95% CI，0.79-1.25; P = 0.962）和匹配人群（16.7%vs.18.3%;校正HR，0.91; 95%CI，0.70-1.19; P = 0.509）。结论：与未进行负荷试验的PCI患者相比，接受EST的择期PCI患者的全因死亡或MI风险降低。
Background: Although current guidelines recommend noninvasive stress tests prior to elective percutaneous coronary intervention (PCI), it is unknown whether antecedent exercise stress test (EST) affects the outcomes of patients undergoing PCI for stable ischemic heart disease (SIHD). This study aimed to investigate long-term outcomes in patients undergoing elective PCI with or without EST.Methods: We studied 2,674 patients undergoing elective PCI using drug-eluting stents for SIHD. Patients were divided into the 2 groups: the test group underwent EST with a positive result within 180 days prior to PCI (n = 668), whereas the non-test group did not undergo any noninvasive stress tests (n = 2,006). The primary outcome was all-cause death or myocardial infarction (MI).Results: Over 5 years after the index PCI, the risk of all-cause death or MI was significantly lower in the test group than in the non-test group in overall population (3.3% vs. 10.9%; adjusted hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.22-0.55; P < 0.001), and in propensity score-matched population (668 pairs) (3.3% vs. 6.3%; adjusted HR, 0.52; 95% CI, 0.30-0.89; P = 0.018). However, the incidence of any revascularization was similar between the 2 groups in overall (16.7% vs. 16.8%; adjusted HR, 0.99; 95% CI, 0.79-1.25; P = 0.962) and matched population (16.7% vs. 18.3%; adjusted HR, 0.91; 95% CI, 0.70-1.19; P = 0.509).Conclusion: Patients who underwent elective PCI with EST had a reduced risk of all-cause death or MI than those undergoing PCI without stress tests.